Crawford分類Ⅱ型胸腹部大動脈瘤に対する腹部分枝デブランチを含む段階的ハイブリッド手術の1例

Staged Hybrid Repair Including Abdominal Branches Bypass Grafting for Crawford TypeⅡ Thoracoabdominal Aortic Aneurysm：Report of a Case

はじめに　胸腹部大動脈瘤（TAAA），特にCrawford分類Ⅱ型TAAAに対する外科治療では，手術侵襲が大きく，脊髄をはじめとする臓器虚血の合併予防の点でも工夫を要する．近年開胸・開腹手術の治療成績は向上しつつあるが，手術リスクの高い症例では適応外となることが多く，血管内治療を併用したハイブリッド治療など低侵襲手術の報告が散見される．

A 64-year-old female with a diagnosis of Crawford typeⅡ thoracoabdominal aortic aneurysm （TAAA） including enlargement of the ascending aorta underwent a staged hybrid repair including visceral artery debranching thoracic endovascular aortic repair （TEVAR）. First, total arch replacement with elephant trunk method was performed, followed by TEVAR for the descending thoracic aorta, and finally visceral artery debranching TEVAR for the thoracoabdominal aorta. Complications such as spinal cord infarction did not occur throughout the procedure. Surgical repair of Crawford typeⅡ TAAA involves a wide range of treatment and is highly invasive, requiring ingenuity in terms of preventing complications such as spinal cord infarction. Hybrid repair including visceral artery debranching TEVAR may be an effective treatment modality for complex aortic lesions including TAAA, but requires careful follow-up including remote complications.